[Duration of labor in primiparous patients. A comparative retrospective study of the last 30 years].
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
P Weiss
Publications and source records attributed to P Weiss.
Evaluation of conventional chest tube therapy for iatrogenic pneumothorax.
STUDY OBJECTIVE: To assess conventional, large chest tube therapy in iatrogenic pneumothorax and to determine the optimal moment when to use more invasive procedures. DESIGN: Retrospective chart review. SETTING: Medical intensive care unit of a university hospital. PATIENTS: Forty-seven patients with needle-induced iatrogenic pneumothorax. Twenty-four patients had an underlying pleural or pulmonary disorder. INTERVENTIONS: After insertion of a 20- to 24-French plastic chest tube connected to an underwater seal, suction was maintained until gas egress stopped or up to 10 days in patients with a persisting gas leak. RESULTS: In 96 percent, a definite occlusion of the pneumothorax was achieved. In all patients without an underlying lung disorder, gas egress stopped definitely after 72 h. In the presence of an underlying lung disorder, 92 percent of the pneumothoraces were healed after 10 days of continuous suction therapy. At 72 h, only 71 percent of the latter group were healed (p < 0.05 vs patients without lung disease). No major complication of chest tube therapy occurred. CONCLUSION: Conventional chest tube therapy is a safe and effective treatment for iatrogenic pneumothorax. In patients with an underlying lung disease, gas egress may last for up to 10 days. In these patients, the earlier use of a more invasive approach may be justified if the air leak persists.
Adult↗
[Sexual orientation and selectivity of perception (experimental study)].
For a group of homosexual (N1 = 20) and heterosexual (N2 = 20) men the authors projected by means of a binocularoscope (apparatus making it possible to project to each eye a different slide) male life models (M), female life models (F) and neutral stimuli (N) in 18 different combinations. The period of exposure was 0.202 s. It was revealed that after concurrent exposure of two slides with different contents the responses of the two groups differed significantly: homosexuals perceived males (M) more frequently than females (F) and neutral stimuli (N), while heterosexuals perceived more frequently females (F) than males (M) and neutral stimuli (N). In both groups probands predominated who gave the majority of replies consistent with their sexual orientation. According to the authors the results provide evidence that perception is influenced by the sexual orientation of the subject. They assume that the described phenomenon can be used also when assessing the sexual orientation in sexuological diagnostic practice.
Adult↗
[Psychological characteristics of deviant sexual aggressors].
Based on psychological examination of 20 paraphilia sexual aggressors the authors focused attention on assessment of specific personality characteristics of this patient group. The results of MMPI, DOPEN and Hand test suggest that their problems are not confined only to the sphere of sexual motivation and sexual socialization. They indicate maladaptation in interpersonal relations (hostility, lack of responsibility, suspicion, lack of empathy), emotional maladaptation (low sensitivity, absence of feeling of guilt) and increased probability of generally aggressive and criminal behaviour (predominance of aggressive and directive attitudes in relation to socially cooperative tendencies). In the authors' opinion these personality characteristics can be, when compared with other diagnostic groups of paraphiliacs, considered specific for the investigated group of sexual aggressors.
Adolescent↗
[The "OPIACE" system. Clinical and diagnostic approach of insomnia in adults].
Explore the source record for details and available documents.
Adult↗
[Problems in mandatory sex therapy].
The authors focus attention on analysis of advantages and problems of the Czech model of imposed treatment of criminal sexual deviants. Relatively favourable therapeutic results are in their opinion due above all to the very good standard of sexuological diagnosis, the theoretical background of the Czech sexuological school, to comprehensive therapeutic action, incl. the continuous character of in- and out-patients treatment. Unfavourable features are in their opinion lack of uniformity as regards indications for institutional treatment, gradual abolition or restriction of sexuological departments and the persisting admission of incurable, dangerous delinquents to mental sanatoria and the non-existence of special detention institutes for criminal recidivists.
Forensic Psychiatry↗
[Ethical problems in modern sexology].
The paper is focused on problems of sexual minorities. The authors discuss their position in society, terminological problems and in particular questions associated with ethical problems of treatment of paraphilics. The authors differentiate between essential, possible and not indicated therapeutic provisions. They also focus attention on ethical aspects of different types of treatment of sexual delinquents (surgical, pharmacological and psychotherapeutic methods), whereby they emphasize in particular the necessity to obtain the patient's informed consent. According to the authors skilled therapy gives a chance to reintegrate the paraphilic patient into society and to protect victims delinquent sexual behaviour.
Ethics, Medical↗
[Prevention of iodine-induced hyperthyroidism after coronary angiography].
Coronary angiography (CA) is followed by an iodine load of 15 to 20 mg for the thyroid and may be the cause of iodine-induced hyperthyroidism. 60 consecutive patients hospitalized for CA without any thyroid history were examined and 56 had thyroid diseases with normal thyroid function. 33 patients still showed a significant decrease of 20 min Technetium uptake (TcU) and an increase of urine iodine excretion because of iodine excess 12 weeks after CA. 3 patients developed latent hyperthyroidism. 27 patients received medication of 1 g natrium-perchlorate and 60 mg methimazole 24 hours before and on the day of CA. These patients showed normal TcU and urine iodine excretion 4 and 12 weeks after CA. 1 out of these 27 patients developed overt hyperthyroidism but had PTCA without premedication 2 weeks after CA. Since Iodine excess leads to iodine-induced hyperthyroidism even in euthyroids a prophylaxis with perchlorate and methimazole is generally recommended in patients with CA.
Adult↗
The Omnicarbon tilting-disc heart valve prosthesis. A clinical and Doppler echocardiographic follow-up.
From 1986 to 1990, 172 patients with a median age of 60.5 years (range 20 to 79 years) received 187 Omnicarbon valves (109 aortic valve replacements, 48 mitral valve replacements, and 15 double valve replacements). Patients were followed-up for a median observation period of 2.5 years (range 4 months to 5.2 years) by clinical and Doppler echocardiographic examination. Follow-up was complete in 98%. Operative mortality (death within 30 days) was 1.7%, and linearized late mortality was 2.6% per patient-year, corresponding to an actuarial survival rate for operative survivors of 89% after 4 years. The overall 4-year postoperative survival was 87% (93% for aortic valve replacement, 77% for mitral valve replacement). Compared with age- and sex-adjusted Swiss death rates, there was an excess mortality of 5% after 4 years. Percentages for freedom from valve-related complications at 4 years are as follows: thromboembolism, 98% (aortic valve replacement, 98%, and mitral valve replacement, 96%); anticoagulant-related hemorrhage, 95%; valve endocarditis, 96%; reoperation, 96%; and permanent valve-related impairment, 99%. The overall 4-year event-free survival was 76% (80% for aortic valve replacement and 69% for mitral valve replacement). New York Heart Association class improved in 88% of the patients by 1 to 3 grades, and only 3% remained in class III after operation. For the most commonly used aortic valve (23 mm), Doppler echocardiography revealed a peak pressure gradient of 29 +/- 10 mm Hg, a fractional shortening/peak pressure gradient ratio of 1.34 +/- 0.61, and a performance index of 0.35 +/- 0.08. In the most commonly used mitral valve (27 mm), the mean pressure gradient was 4.0 +/- 2.1 mm Hg. We conclude that excellent clinical and hemodynamic results can be obtained with the Omnicarbon prosthesis, in both the aortic and mitral positions.
Adult↗
[Anti-arrhythmia treatment using L-carnitine in acute myocardial infarct].
Carnitine, a quaternary amine (3-hydroxy-4-N-trimethylaminobutyric acid), plays an important physiologic role in fatty acid transport and metabolism as well as in energy production of the myocardial cell. L-carnitine in high doses has been postulated to have an antiarrhythmic effect and this has also been clinically proven. We studied 20 patients with acute myocardial infarction (AMI), 4-12 hours after onset of pain. The patients were randomized and treated double-blind with 5 g L-carnitine (n = 12) or placebo (n = 8) at hours 0, 12, 24, 36, and with 2 x 3 g on days 3 to 7 by intravenous infusion over 2 hours. The two groups were similar for age, sex, infarct site, maximum CPK and conventional antiarrhythmic therapy. 24-hour Holter-ECG was performed on days 1, 2 and 7 and showed no significant difference between the two groups with respect to incidence of ventricular premature beats (VPB) per hour. On the second day following AMI, however, only 4 of 12 carnitine-treated patients showed high-grade VPB (Lown IVa and IVb), in comparison with 7 of 8 patients in the placebo group. The difference is significant: p = 0.028 (Fisher's Exact Test). Carnitine was well tolerated and the efficacy demonstrated on the second day following AMI must be interpreted with caution.
Aged↗
[Acute left heart insufficiency: possible leading symptom of a pheochromocytoma].
A 42-year-old patient with acute left-ventricular failure is described in whom pheochromocytoma was diagnosed only after prolonged and fruitless efforts. Pheochromocytoma may present without the typical features of paroxysmal or sustained hypertension, headache, increased sweating, and palpitations. Therefore, in cases of acute left-sided cardiac failure of primarily undetermined origin, pheochromocytoma should be considered in differential diagnosis.
Acute Disease↗
[Is it justifiable today to perform thrombolysis in only one fifth of the patients with myocardial infarct?].
The one year mortality data of 231 patients entering the hospital with acute myocardial infarction who did or did not undergo thrombolysis are presented. 49 patients (21.2%) received thrombolytic therapy. 31% were excluded from thrombolytic therapy because of age over 70 years, 29% because of the time lag since onset of symptoms (over 6 hours), 61% because of absent ECG criteria and 32% because of other contraindications. The one year mortality rate was significantly lower in patients undergoing thrombolysis (8.2%) versus patients without thrombolysis (20.3%, p less than 0.05). Mortality in patients without thrombolysis and age greater than 70 years was 23.6%, in patients with late entry 20.1%, in those excluded from thrombolytic therapy with missing ECG elevations 17.9% and in patients with contraindications 28%. If thrombolytic therapy was withheld due to age greater than 70 years or late entry only, mortality was high (33.3% and 38.5% respectively; p less than 0.02 versus lysis). This was not true for patients without significant ST elevation: to the contrary 12 of 42 patients without lysis (28.6%; p less than 0.02 versus lysed patients) and greater than or equal to 2 mm ST elevation irrespective of other exclusion criteria died. Since mortality in patients over 70 years of age or entering the hospital more than 6 hours after onset is of such magnitude (especially if there are ECG signs of ongoing ischemia), the risk-benefit ratio should be considered individually to ensure that these high-risk patients are not excluded a priori from thrombolytic therapy.
Adult↗
Regional cerebral glucose consumption measured by positron emission tomography in patients with Wilson's disease.
Using positron emission tomography (PET), the regional cerebral metabolic rate of glucose consumption (rCMRGlc) was measured in 14 patients with Wilson's disease (WD) and 23 normal subjects. In WD patients, cerebellar, striatal and--to a lesser extent--cortical and thalamic rCMRGlc were significantly decreased compared with controls. Striatal rCMRGlc was significantly reduced in those 4 patients who had recently started decoppering therapy as compared with striatal rCMRGlc measured in those 10 patients with longer duration of medication. Caudate rCMRGlc correlated significantly with various signs of extrapyramidal dysfunction. Cerebellar, thalamic and cortical rCMRGlc correlated significantly with the severity of pyramidal signs. These data indicate that the PET measurement of rCMRGlc may be a useful tool to evaluate cerebral involvement in WD and to monitor the response to treatment.
Adult↗
Possible risk for cardiac arrhythmia related to intravenous erythromycin.
OBJECTIVE: To evaluate the incidence of prolongation of the rate-corrected electrocardiographic QT interval (QTc) and of ventricular arrhythmia associated with intravenous administration of erythromycin lactobionate. DESIGN: A consecutive series of 7 critically ill patients treated with intravenous erythromycin for severe pneumonia. SETTING: A medical intensive care unit of a university hospital. MEASUREMENTS AND RESULTS: Registration of QTc duration before and after intravenous administration of erythromycin as a short infusion. Blood chemistry, hemodynamic variables, arrhythmias, and co-medications were recorded. Evaluation of at least 10 ECG intervals by 2 experienced investigators who were blinded as to the time of drug administration. If several measurements were performed in the same patient, only the mean value was used for further analysis. During 12 of 13 drug administrations studied in 7 patients QTc prolongation was observed. The extent of QTc prolongation was significantly correlated with the infusion rate (mg/min, r = 0.765, p = 0.05). In 3 patients ventricular arrhythmia occurred in close temporal relation to the erythromycin infusion; two of them developed ventricular fibrillation shortly after the first and second dose of erythromycin, respectively, and died within 3 h. CONCLUSION: In critically ill patients erythromycin-induced QTc prolongation is a frequent pharmacologic effect correlated with erythromycin infusion rate. To avoid changes in electrocardiographic intervals and thereby possibly potentially life-threatening ventricular arrhythmia administration with the lowest possible infusion rate and close cardiac rhythm monitoring are advisable in these patients.
Aged↗
Doppler evaluation of aortic valve area in children with aortic stenosis.
Explore the source record for details and available documents.
Adolescent↗
[Steroid and protein hormone concentrations in serum and follicular fluid after stimulation for in vitro fertilization].
Sixty patients with tubal infertility were stimulated for IVF with a fixed schedule consisting of clomiphene and pure follicle stimulating hormone. They responded with an optimal estradiol increase and 2 to 4 embryos were transferred. Conception cycles (n = 17) could be differentiated from non-conception cycles (n = 43) by serum estradiol, serum progesterone, the serum progesterone/estradiol-ratio and serum LH concentrations. Testosterone, androstenedione and FSH in serum and follicular fluid showed no significant relation to a possible therapy outcome. We conclude from our findings, that, during the peri-implantation period, certain LH patterns followed by an optimal progesterone/estradiol-ratio in the serum support an embryo survival after transfer to the uterus.
Androstenedione↗
Absence of nitroglycerin-induced heparin resistance in healthy volunteers.
A previously described nitroglycerin-induced heparin resistance could not be verified by in-vitro experiments or in a randomized, double-blind, crossover trial in healthy volunteers. A clinically relevant attenuation of the anticoagulant effect of a heparin bolus (40 U.kg-1) by a concomitant infusion of nitroglycerin (100 micrograms.min-1) was absent. Activated partial thromboplastin time was not significantly different under nitroglycerin infusion as compared to placebo after heparin injection. Concentrations and activities of antithrombin III and heparin cofactor II remained unchanged during nitroglycerin infusion. An interaction of these two frequently combined drugs in patients with active thromboembolic disease or after a prolonged concomitant intravenous administration cannot be ruled out. Since this is of clinical importance, further studies must clarify a possible nitroglycerin-induced heparin resistance.
Adult↗
Doppler sonographic evaluation of mechanical and bioprosthetic mitral valve prostheses during exercise with a rate corrected pressure half time.
OBJECTIVE: To compare the effect of exercise on pressure half time in patients with mechanical or bioprosthetic mitral valves. A relative pressure half time (pressure half time as a percentage of RR interval) was used in an attempt to correct for the shortening of the diastolic time interval caused by the increase in heart rate during exercise and thus to uncover the effects of valve design on pressure half time during exercise. PATIENTS: Twenty clinically stable (New York Heart Association grade I-II) patients with mechanical (n = 12) or bioprosthetic (n = 8) mitral valves (median age 51) years. The median time since valve replacement was 42 months. METHODS: Continuous wave Doppler echocardiography from the apical view at rest and during moderate supine bicycle exercise (50 W). RESULTS: During exercise the mean (SD) heart rate increased from 79 (12) to 101 (12) beats per minute (95% confidence interval (95% CI) of difference, 15 to 29/min) and the peak pressure gradient from 11 (5) to 18 (6) mm Hg (95% CI of difference 5 to 9 mm Hg). The pressure half time decreased from 114 (30) to 78 (26) ms (95% CI of difference (30-42 ms). There was no difference between the valve types. The relative pressure half time remained unchanged in patients with mechanical valves during exercise (13 (4) rest and 13 (5)% exercise, respectively) and decreased in patients with bioprostheses (17 (3) and 12 (3)%, respectively (95% CI of difference 2 to 8%, p = 0.025). CONCLUSIONS: In patients with mechanical mitral valves the decrease in the pressure half time during exercise is probably mostly the result of the shortening of the diastolic time interval with increasing heart rate whereas in patients with bioprosthetic valves an increase in functional valve area may contribute to the shortening of pressure half time during exercise.
Adult↗